Abstract
Background: Normal pressure hydrocephalus (NPH) is characterized by the triad of dementia, gait disturbance and urinary incontinence, all potentially reversible following a ventriculoperitoneal shunt (VPS). This study aims to evaluate the clinical outcomes of shunting in normal pressure hydrocephalus following a new standardized protocol. Methods: This study is designed according to the STROBE guidelines. Demographical, clinical, surgical and radiological data were collected from May 2015 to November 2019. Gait, balance and incontinence data based on the NPH European scale were collected before and after one, six and twelve months of treatment with a VPS. Clinical symptoms and changes of the stoke volume, measured on phase-contrast MRI, were used to evaluate improvement after VPS surgery. Results: One hundred and eighty-one consecutive patients met the inclusion criteria. The mean age was 73.1 years (59–86) and mean follow-up was 38.3 months (13–50). The gait (58.5 ± 14.3 to 70.1 ± 13.4, p < 0.001), the balance (66.7 ± 21.5 to 71.7 ± 22.1, p = 0.001), continence domain (69.9 ± 20.5 to 76 ± 20, p = 0.002) scores and neuropsychological scales showed a statistically significant improvement over the follow-up. The overall improvement after 12 months was present in 91.2% of patients. An overall complication rate of 8.8% and a reoperation rate of 9.4% were recorded, respectively. Conclusions: Surgical treatment by VPS for NPH improves symptoms in most patients, when accurately selected. A standardized protocol and a multidisciplinary team dedicated to this disorder is needed to achieve an early and correct diagnosis of NPH. Follow-up with stroke volume measurement is a valuable tool for the early diagnosis of shunt malfunction or the need for valve adjustment.
Highlights
Introduction iationsNormal pressure hydrocephalus (NPH) is typically characterized by the triad of dementia, gait disturbance and urinary incontinence, all potentially reversible following a ventriculoperitoneal shunt (VPS)
A total of 195 patients underwent VPS surgery for NPH at our neurosurgical departments in the investigation period: 14 (7.2%) patients were excluded because they were lost during follow-up for different reasons, and 181 (92.8%) patients matched the inclusion criteria and were included in the present investigation
* Backward stepwise method in binary logistic regression analysis; the non-significant factors are eliminated during analysis. This multicenter prospective observational study on the clinical outcomes of shunting in NPH patients resulted in the following clinically relevant conclusions: (1) a multidisciplinary team focused on this disease and a uniform protocol is needed to accurately select patients and achieve a correct diagnosis of NPH; (2) surgery with VPS improves gait, balance and continence domain and some of the neuropsychological domain with an impact on quality of life and daily activities of patients; (3) the efficacy of shunting occurred within
Summary
Normal pressure hydrocephalus (NPH) is typically characterized by the triad of dementia, gait disturbance and urinary incontinence, all potentially reversible following a ventriculoperitoneal shunt (VPS). Difficulties in differential diagnosis with neurodegenerative diseases result in a delay and/or lack of treatment, preventing recovery with dramatic consequences in terms of clinical deterioration and growing socioeconomic costs [1,2]. Despite the mechanical nature suggested by the name, recent studies focused on periventricular white matter and its vascular supply degeneration as a possible cause [3,4]. NPH diagnosis is based on clinical and radiological exams, which, show high variability in terms of sensitivity and specificity, probably due to the heterogeneity of the methods employed [5,6]
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